PURPOSE: To investigate the pulmonary outcomes of early extubation (within the first 24 hours of life) with synchronized nasal intermittent positive pressure ventilation (NIPPV) in extremely premature infants born at 25-26 weeks' gestation. METHODS: Medical records of extremely premature infants (gestational age: 25-26 weeks) born and admitted to the Keimyung University Dongsan Medical Center between January 2015 and December 2015 (n=42) were reviewed retrospectively. The early extubation group included infants who were extubated within the first 24 hours of life and was compared with a control group that included infants who remained ventilated beyond the first 24 hours of life. Extubation failure was defined as the need for reintubation within 72 hours after extubation. RESULTS: Of the 35 enrolled infants, 22 (62.9%) were extubated within the first 24 hours of life. No significant differences in perinatal factors were observed between the early extubation and control groups. Between the two groups, the incidence rates of extubation failure (18.2% [4/22] vs. 7.7% [1/13], P=0.39), reintubation (50.0% [11/ 22] vs. 46.2% [6/13], P=0.84), mortality (18.2% [4/22] vs. 15.4% [2/13], P=0.83), and the combined rates of clinical bronchopulmonary dysplasia (BPD) or death (40.9% [9/22] vs. 38.5% [5/13], P=0.89) did not significantly differ. CONCLUSION: Early extubation (within the first 24 hours of life) with synchronized NIPPV is safe and effective in the extremely premature infants born at 25-26 weeks' gestation, and does not indicate increased risks of extubation failure and other morbidities.